Individual
CHANEL ANGEL MIMMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
885 GOLD HILL RD # 3104, FORT MILL, SC 29708-7946
(803) 902-5943
Mailing address
280 SENATOR RD, LAKE WYLIE, SC 29710-8003
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/10/2026
Last updated
06/10/2026
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